After about six weeks of rehabilitative interventions, Mr. Dee was evaluated to see how he had progressed. Functionally, he had made great improvements related to the recovery of the spinal cord. The new ASIA measurements showed that both motor functions and sensitivity had improved in hands, arms, and legs, moving him up an impairment grade from C to D (meaning at least half of the key affected muscle groups have a grade of 3 or higher). These improvements also translated to increased SCIM scores (from 21 pre-Cycle to 72), where one can see the manifestation of the gains in functioning.
Better self-care, respiration, bladder and bowel management, and overall mobility were evident. Areas that only slightly improved were his ability to manage stairs and his transferring skills.
With regard to the goals set, each of the Cycle Goals was achieved. Abilities for self-care even exceeded expectations. As a result of his improved hand and arm functions and fine hand use, he could perform all of the self-care activities alone, and though these activities were time-intensive, it meant that he would not necessarily require his wife’s assistance.
What remained for Mr. Dee regarding body functioning were only mild to moderate problems, primarily in mobility. Spasticity remained problematic and had an important negative impact on his walking abilities and consequently increased his risk of falling; therefore he continued to require an assistive walker.
Regarding his prognosis, Mr. Dee’s physical therapist offered a final thought:
Mr. Dee’s strength has much improved and he should be able to walk independently with an assistive walker – at least for short distances. There might still be some improvement yet to his arm and hand functions. A problem that will remain is that he will no longer be able to work as a farmer.
Challenges in reintegrating into the community
However, recovery is not limited only to body functions and activities. Significant challenges yet remained for Mr. Dee in reintegrating into his community.
There were a number of access issues. His stilt house, for example, had no stairs for access. The health team could only make the recommendation that he have stairs built to facilitate access; however, how this was to be paid for or undertaken was left to Mr. Dee. There were unfortunately no available resources for such modifications.
Table 4: SCIM scores during and after the Rehab-Cycle®
Additionally, the distance to the household toilet was too great and the rehabilitation team recommended adapting a plastic chair and pail as a type of modified toilet to be utilized at night.
Importantly, one issue that was not addressed was his future occupation. Work as a farmer was unlikely to be feasible given his existing limitations. With his level of education, his options were limited. It was hoped he would be eligible for state disability funds, but this was not a given.
His social worker informed him that his injuries may not have resulted in disabilities that were covered.
At the conclusion of Mr. Dee’s single Rehab Cycle, he returned home anticipating that his daughter’s future income could be used to support the family once she completed her studies.
"In general, within rural areas of Thailand, money may not be the most important of factors. Family support and subsistence farming must often make up for where there is a lack of financial resources."
Dr. Dee's physical therapist